Provider First Line Business Practice Location Address:
4717 S PITTSBURG ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99223-6556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-879-1372
Provider Business Practice Location Address Fax Number:
509-448-3691
Provider Enumeration Date:
03/01/2014